Design of a Composite Material Axillary Crutch

Jorge Barco1 , JL Mantari2

1 University of Engineering and Technology (UTEC), Lima,
Peru

Abstract— Users of axillary crutches report many common A. Sense the Gap
problems. These include high energy expenditure and strain
on armpits and hands as a result of the impact. This paper
As mentioned in the introduction, the current standard
provides a new crutch design with ergonomic and mechanical model of axillary crutches is a source of problems and
considerations. A curved body provides shock absorption, while discomfort for their users. Patients are forced to use crutches
composite materials contribute strength with low weight. The for the duration of their recovery, which may take several
crutch presents a safety factor of 5.81 when loaded with weeks. The crutches should provide the most comfortable
the most critical forces in the swing-through gait in Ansys
Structural, and it also performs better in terms of energy
experience for the users during this difficult period of time.
expenditure, which implies a less tiresome experience for the Improvements in the design of crutches are needed to provide
user, when simulated in Anybody Modeling System. a better crutch experience.
B. Needs
I. INTRODUCTION
As the first step, the list of needs is established based on
Orthopedic crutches remain a great tool for rehabilitation observation and study of the potential users and the problem.
of non-weight bearing lower leg injuries. Nevertheless, not Interviews were conducted with crutch users, their move-
enough resources have gone into improving the conditions of ments are also observed. The needs are classified and ranked
its use. Common problems that arise with the use of crutches according to their relative importance. Table 1 presents some
have not been addressed. High energy expenditure, injuries of these needs documented in this project.
in the axilla and the hands, nerve compression are some of
TABLE I
these problems, according to Hinton [1] and Miski [2].
U SER NEEDS
Some studies highlight the possibilities for improvement
in the design of crutches. Shoup and Fletcher [3] recommend
Need Importance
the possibilities of minimizing the upper body motion and Lightweight 5
the shock associated with plating on the crutch tip. Other Low-energy expenditure 5
studies have evaluated the use of spring-loaded crutches [4], Shock absorbent 5
[5] with diverse results. Regarding actual prototypes, the Painless/Comfortable 5
Easily transportable 4
works of Shortell [6], Ballari [7] and Fasman [8]. Of note are Wear Resistant 4
the use of composite materials, the curve-designed body for Aesthetically pleasing 3
better performance and the use of torsional springs for user
comfort. However, all of them are missing true metabolic
studies, instead relying mostly on user feedback. While this C. Specifications
guarantees a comfortable product, it does not truly prove their
Once the needs have been established, values are assigned
design is better than the standard model in a more objective
based on literature review. Ideal values completely satisfy the
way.
assigned needs, while marginal values satisfy them partially.
The purpose of this project is to propose a new axillary Marginal and Ideal values for certain needs are presented in
crutch design that incorporates a set of improvements over Table 2. Muscle Activation Level (M.A.L) is used as a unit
the standard model. The aim is to reduce or eliminate, and is explained on the AMS Validation section of this paper.
if possible, the present problems with the current crutch
models, especially the ones related to comfort and energy TABLE II
use. This new design is validated with both biomechanical S PECIFICATIONS
and structural simulations.
Need Ideal Marginal Unit
II. M ETHODOLOGY Lightweight < 0.7 1.2 kg
Low-energy expenditure 0.8 0.85 M.A.L.
Maintenance <4 <6 pieces
This project follows the methodology proposed by Ulrich
Weight Capability 120 100 kg
and Eppinger[9] which is described below. Strength (Ult. Comp. Strength) 500 300 MPa
D. Functional Analysis then the results presented. Nevertheless, several iterations of
The functional analysis must incorporate the main and the design are produced and studied in order to reach these
secondary functions of the design. This analysis provides results.
a way to understand the product in an abstract way, without
factors like shape, dimensions or materials. It also works
as the input for the morphological chart in the concept
generation step. The function diagram showing the functions,
both main and secondary, is shown in Fig. 1.

Fig. 3. Flow diagram for the design process.

III. E RGONOMIC D ESIGN

A. Length
The axillary crutch length must be tailored to each user.
Normally, crutch lengths are determined by testing several
lengths until the user feels comfortable. Studies conducted by
Fig. 1. Function diagram of the crutch. [10] and [11] have tested methods for estimating the correct
crutch length based on different measurements of the user.
E. Concept Generation For the crutch design, Equation (1) is used to calculate the
crutch length (L) based on the user’s height (h), both in cm:
The functional analysis provides the basis for the concept
generation stage. A morphological chart is made from the
L = 0.779h − 2.5. (1)
functions established in the functional analysis. This chart
includes categories like structure, shock absorption method, B. Handles and Armpit Cuff
handle type, transportation method and traction. For each of An important source of discomfort for crutch users is the
these categories, a set of particular solutions is generated non-ergonomic design of both the handles and the armpit
based on preexisting or new concepts. An example of this cuffs. The handle is a specially critical point because it
process is shown is shown in Fig 2. is where most of the weight is supported. An incorrect
handle design can cause pain and lead to carpal tunnel
syndrome (CTS), according to Sala et al. [12]. For maximum
comfort, the handle should ensure that the wrist is in a
neutral position while grabbing the crutch [13]. Samsonaite
Fig. 2. Example of the generation of a solution concept from the [14] provides some other guidelines for designing the crutch
morphological chart handle, including suggested measurements and materials. In
the case of the cuff, an incorrect design can lead to the user
feeling uncomfortable while moving. The shape of the cuff
F. Concept Selection
must complement the contour of the users armpit. Such a
Once the morphological chart is established, a conceptual design is presented for this project in Fig 4.
solution can be generated from selecting a particular solution
from each of the categories. Several of this conceptual
solutions are then ranked and compared on their ability to
satisfy the user needs. To generate this ranking, the user
needs are grouped into five categories: comfort, movement
ability, trustworthiness, complexity and aesthetics.
The solution selected is a foldable custom-made curved
body crutch, with Lofstrand-style handles on the front, with
a plastic tip.
G. Iterative Design
It is important to note this project followed a iterative
design process, which can be observed in Fig. 3. The crutch
design is evaluated by simulations, and the results analyzed
in order to continue improving the model. This paper shows a Fig. 4. Proposed ergonomic design for the armpit cuff.
linear process in which the crutch is designed, simulated and
C. Main Body Where: G(f (M ) ) is the objective function that determines
(M )
the recruitment of muscles in the body, fi are the muscle
The main body of the crutch has a curved shape. This
forces and Ni are the strength of the muscles.
provides shock absorption to the design and reduces the
strain on the body due to repetitive impacts [15]. Such a
design has already been tried in a forearm crutch by Shortell
et al [6] and in an axillary crutch by Buckley [15]. For
this project, two main curve shapes are proposed, shown
in Fig. 5. The shapes are tested on Ansys Structural to
determine the best alternative in terms of deformation and
stress distribution. An s shaped curve is selected. Fig. 6. Inverse dynamics process.

A. Swing-through Gait
For non-weight bearing injuries, the swing-trough gait is
a common method of motion with crutches. The crutches
advance first, and then the healthy foot is swung past them.
Data for the swing-through gait is recovered from a user
performing the gait with a normal set of crutches, shown in
Fig 7. His movement with the crutches is recorded on video.
Values for the position of the user and the crutches, as well
as the angles between the body parts are recorded for several
points in the movement taken from the frames of the video.
These values served as the input for the AMS simulation.
Since motion tracker data for this gait was unavailable, this
method provided an alternative.

Fig. 5. Proposed shapes for crutch. On the left is the 7 shaped curve and
pn the right is the S shaped curve.

IV. A NYBODY M ODELING S YSTEM

Anybody Modeling System (AMS) is a simulation soft-

ware capable of analyzing the human musculoskeletal body.
It allows the modeling of the human body in different
situations and provides data regarding muscle activation
levels, muscle forces and other important variables for topics
including design optimization and gait analysis.
AMS is based on the inverse dynamics approach of muscu-
loskeletal modeling. It computes the muscle activation based
on the input motion. Using a set of Cartesian coordinates,
the positions of all segments of the biomechanical system
are computed, along with their velocity. The accelerations
are also calculated, in order to fully specify the motion. Fig. 7. Footage used for the swing-through gait simulation.

With these parameters, the equations for the dynamic

equilibrium are established. This process is what is known as
inverse dynamics. However, there are many configurations of
muscle forces that could solve the dynamics of the motion.
To solve the inverse dynamics, AMS uses a minimum muscle
fatigue criterion shown in Equation (2) [16]. This criterion
provides the set of muscle forces that minimize muscle
activation levels the most. Fig. 6. shows a diagram of the
process for calculating the muscle forces.
(M )
! the crutches. A total of 1.09 seconds pass between the foot
(M ) fi
G(f ) = max (2)
Ni
B. AMS Simulation of Swing-through Gait
The swing-through gait with a normal axillary crutch
is simulated using AMS. A human model from the AMS
repository is used. The model is adjusted to the dimensions
of the user so that it is 1.79 m tall and it weighs 86 kg. The
crutches are simulated as rigid segments of 1.37 m of length
and 1.2 kg each. The hands of the model are constrained to
the crutch handles, while the armpits are situated on top of
leaving the ground behind the crutches and it reaching the
ground in front of the crutches, measured with the frames of
the video of the participant. From the simulation, the reaction
forces at the ground, the reactions experienced in the handles
and the ones experienced in the armpits are calculated. These
are corroborated with results from other sources, such as
experiments by Reisman et al [17] and Liu et al [18]. These
set of results determine the structural design of the crutches
and provide a comparison for the new crutch design. Fig.
8 shows the visual representation of the AMS simulation,
while the results for the reactions forces are shown in Fig.
9.
Fig. 8. Visual representation of the AMS simulation.
Fig. 9. Reaction forces at the ground, handle and underarm for both
crutches in the AMS simulation.
V. S TRUCTURAL D ESIGN
A. Material Selection
For the process of the material selection, the methodology
proposed by Ashby in [18] is used, along with the CES
selector software. To choose the materials for the crutches,
certain parameters must be maximized or minimized in order
to get the design that best fits the needs of the user.
Since the crutches support compressive loads, its function
can be likened to that of a column. The length of the crutch
is given but it must be of the lowest possible weight. The
mass is given by Equation (3). Meanwhile, the buckling load
given by Equation (4) provides the maximum load the crutch
can support without buckling. Substituting Equation (3) in
Equation (4), considering a circular area for the column,
gives a new expression for the mass given by Equation (5).
Setting aside the factors not related to the material and using
the inverse of Equation (5), a new material index M1 is
given by Equation (6). Maximizing M1 provides a selection
of materials that best support compressive loads with the
minimum amount of material.
m = ALρ (3)
π 2 EI
Fcrit = (4)
L2
4Fcrit 1/2 ρ
m=( ) (L)2 1/2 (5)
π E
E 1/2
M1 = (6)
ρ
Where: m is the mass, A is the cross sectional area, L is
the length of the column,ρ is the material density, Fcrit is
the buckling load, E is the elastic modulus, I is the second
moment moment of area A, L is the length of the column
and ρ is the material density.
Meanwhile, the crutch must also work as a spring, while
minimizing the weight as well. Therefore, the parameter to
maximize is the elastic energy stored per unit mass, which
is given by Equation (7). Ignoring the factors unrelated to
the material, a material index M2 is given by Equation (8).
Maximizing this value results in a selection of materials that
best work as springs regardless of the shape.
1 σf2
W = (7)
2 ρE
σf2
M2 = (8)
ρE
Where: m is the mass, A is the cross sectional area, L is
the length of the column,ρ is the material density, Fcrit is
the buckling load, E is the elastic modulus, I is the second
moment moment of area A, L is the length of the column
and ρ is the material density.
 Using the library of CES selector, the materials were
screened according to the values of both M1 and M2 . The re-
sults are tabulated on Table 1. The materials that fulfill these
characteristics are aluminum alloys, glass-fiber reinforced
plastics (GFRP) and carbon fiber reinforced plastics (CFRP).
Of these three, both reinforced plastics perform particularly
well and since carbon fiber has the superior strength, it is
the selected material.
TABLE III
M ATERIAL S ELECTION R ESULTS
The distribution of stress in the crutch is also obtained,
shown in Fig. 11. It can be observed that middle part of the
crutch is where the lowest amount of stress is found, while
the most critical points are beneath the handle. The hinge is
then located above the handle, in order to make the crutch
foldable. The deformation distribution in the crutch is also
determined. The crutch did not bend excessively, ensuring
that the user feels stable.

Material M1 (Gpa1/2 .m3/M g) M2 (kJ/kg)

GFRP 3.21 1.07
CFRP 6.51 0.522
Aluminum Alloys 2.44 2.51

B. Laminate Design
ANSYS Composite Prep/Post (ACP) is used to design
the material composition of the main body of the crutches.
Epoxy UD 239 GPa is used from the library included in the
software. The main variables for this step of the design are
the layer thickness, the fiber orientation and the number of
layers. The final laminate design has 28 layers with a layer
thickness of 0.5 mm for a total thickness of 14 mm, with a
lamination of [02 (±30)2 02 ±60 02 ± 45]s.
C. Static Analysis
Ansys Structural is used to validate the design based on the
loads calculated on the AMS simulation. The most critical
point of the gait is analyzed to determine if the crutch failed.
The loads were located on the handle and the crutch pad,
while the crutch tip worked as the fixed point on the ground.
The Composite Failure tool determined the safety factor
based on the Puck criterion and the Tsai-Wu criterion. The
results, as seen in Fig. 10, show a minimum safety factor of
5.81 for the crutch.
Fig. 10. Ansys Structural results for the safety factor of the crutch.
Fig. 11. Distribution of stresses in the crutch
D. Spring Stiffness
Research studies regarding the usefulness of spring-loaded
crutches is varied. Ackermann [19], Lius[20] and Segura
[21] give conflicting results for the optimal value of the
spring stiffness, ranging from 4.5 kN/m to 22.4kN/m. The
curved shape of the main body serves to absorb part of
the shock from the impact with the ground, but it cannot
achieve the performance of a true spring. Nevertheless, an
equivalent value for stiffness of the crutch is found using
Ansys Structural, by applying a vertical load and recording
the vertical deformation. This stiffness is equal to 91 kN/m.
E. AMS Validation
A second AMS simulation is conducted with the new
crutch design. The crutch model is updated with the new
redesign. These results were compared to the results of the
swing-through gait with the normal set of crutches. The
muscle activation levels provide a comparison for both sets of
crutches. The muscle activation level is the ratio of the force
exerted by the muscle to the maximum force it can generate,
meaning it ranges from 0 to 1. A higher value for the muscle
activation level means the muscle is working more. AMS
provides the highest activation levels in the whole body, but
it can also show the activation levels for specific muscles.
As shown in Fig. 12, the normal set of crutches has higher
maximum activation levels, while also having higher muscle
activation levels in muscles like the trapezii, the deltoids and
the triceps. All of these muscles are heavily involved during
the swing-through gait.
The results indicated that the positioning of the handles has
the biggest effect on the activation levels of the muscles. This
is because the arms will have to bend differently for different
handle positions. A straight arm produces the highest amount
of muscle activation levels, therefore designs should strive to
force the user to bend his arms.
AMS has a high potential for design. By iterating the
crutch model with different measurements and analyzing
the results, an optimized design can be produced. Since the
comfort of the user is so important when designing user-
centric products like crutches, AMS serves as a tool for
the initial stages of the design when no physical prototypes
have bee made. Furthermore, AMS also aids in later stages,
by analyzing how the human body reacts to the prototypes
produced.
F. Final CAD Design
Finally, the CAD design of the crutch is completed, with
the front handles, the axillary pad, the crutch tip, the curved
body and the hinge that allows the crutch to fold. Shown in
Fig. 13.
VI. CONCLUSIONS
The field of biomedical design has an opportunity in
crutches. It is a product that has yet to address many of
the problems it brings. A new model of crutch is designed
to solve some of these problems. Following a user centric
methodology, this new design is based on ergonomic studies,
while incorporating other innovative solutions. The gait of
a patient using crutches is analyzed. Composite materials
were selected and serve as the main building material. The
crutches were structurally tested, as well as simulated using
a musculoskeletal simulation software to ensure a better
user experience. Future work should focus on prototyping
of the crutch, user testing and recording for musculoskeletal
analysis.
ACKNOWLEDGMENT
To everyone who helped in the making of this project. Fig. 12. Comparison of muscle activation levels with a normal set of
Thanks to Diego for his dedication in helping with the crutches and the new design. (placeholder image)
project, to Jorge and to all of my fellow students.
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